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Kin 188 General Medical Conditions


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Kin 188 General Medical Conditions

  1. 1. KIN 188 – Prevention and Care of Athletic Injuries General Medical Conditions
  2. 2. Introduction <ul><li>Cardiovascular disorders </li></ul><ul><li>Neurological conditions </li></ul><ul><li>Respiratory tract conditions </li></ul><ul><li>Gastrointestinal conditions </li></ul><ul><li>Endocrine conditions </li></ul><ul><li>Infectious diseases </li></ul><ul><li>Dermatological conditions </li></ul><ul><li>Special population conditions </li></ul>
  3. 3. Cardiovascular Conditions <ul><li>Blood and lymph disorders </li></ul><ul><li>Syncope </li></ul><ul><li>Shock </li></ul><ul><li>Blood pressure disorders </li></ul><ul><li>Sudden cardiac death </li></ul><ul><li>Non-cardiac causes of sudden death </li></ul>
  4. 4. Blood and Lymph Disorders <ul><li>Anemia </li></ul><ul><ul><li>Iron-deficiency anemia </li></ul></ul><ul><ul><li>Sickle cell anemia </li></ul></ul><ul><li>Hemophilia </li></ul><ul><li>Reye’s syndrome </li></ul><ul><li>Lymphangitis </li></ul>
  5. 5. Anemia <ul><li>Defined as reduction in either red blood cell volume or hemoglobin (Hgb) concentration </li></ul><ul><li>Iron-deficiency anemia </li></ul><ul><ul><li>Iron-deficiency characterized by deficient Hgb synthesis </li></ul></ul><ul><ul><li>Most common in adolescent girls and women of childbearing age from menstrual blood loss and increased iron demand during pregnancy </li></ul></ul><ul><ul><li>Treat with dietary iron supplements and vitamin C for iron absorption </li></ul></ul><ul><li>Sickle-cell anemia </li></ul><ul><ul><li>Most common in African-Americans </li></ul></ul><ul><ul><li>Results from abnormalities in Hgb structure that produce a characteristic sickle-shaped red blood cell that cannot transport oxygen </li></ul></ul><ul><ul><li>Sickle cells clump together and often block vessels causing organ failure </li></ul></ul><ul><ul><li>No known treatment, hydration and modified exercise considerations (environment, duration, etc.) </li></ul></ul>
  6. 6. Blood and Lymph Disorders <ul><li>Hemophilia </li></ul><ul><ul><li>Bleeding disorder associated with deficiency of body’s blood-clotting system </li></ul></ul><ul><ul><li>Presents with large/deep bruises, prolonged bleeding from minor wounds </li></ul></ul><ul><li>Reye’s syndrome </li></ul><ul><ul><li>Disruption of urea cycle in body resulting in ammonia in blood, hypoglycemia, severe brain edema and critically high intercranial pressure </li></ul></ul><ul><ul><li>Almost always follows URI of viral nature (varicella and flu most common, but also can be from common cold) </li></ul></ul><ul><ul><li>Rare condition which may result in coma or death if not recognized and treated appropriately </li></ul></ul><ul><li>Lymphangitis </li></ul><ul><ul><li>Inflammation of lymphatic channel secondary to infection distal to channel </li></ul></ul><ul><ul><li>Most common presentation is swollen lymph nodes (groin – LE, axilla – UE) </li></ul></ul>
  7. 7. Syncope <ul><li>Sudden, transient loss of consciousness (“fainting”) occurring in healthy individuals </li></ul><ul><li>Most frequent cause is neural mediated syncope (NMS) from sudden drop in blood pressure reducing circulation to brain leading to loss of consciousness </li></ul><ul><li>Other causes may be related to heat illness, dehydration, emotional stress, cardiac arrhythmias and changes in blood volume or distribution </li></ul><ul><li>Initial management includes lying the individual down safely and assessing vital signs – recovery usually occurs within minutes, activate EMS if not and recurrent episodes should be evaluated by MD </li></ul>
  8. 8. Shock <ul><li>Occurs if heart unable to exert adequate pressure to circulate enough oxygenated blood to organs </li></ul><ul><li>May be from damaged heart that fails to pump properly, low blood volume from blood loss or dehydration or because blood vessels dilate causing blood to pool in large vessels away from vital areas </li></ul>
  9. 9. Shock <ul><li>Most prevalent symptoms are associated with vital signs </li></ul><ul><ul><li>Rapid, weak pulse </li></ul></ul><ul><ul><li>Rapid, shallow respirations </li></ul></ul><ul><ul><li>Decreased blood pressure </li></ul></ul><ul><li>Skin turns cool/pale/clammy – lips and nail beds may become cyanotic </li></ul><ul><li>Represents a medical emergency and is potentially life-threatening </li></ul>
  10. 10. Blood Pressure Disorders <ul><li>Hypertension </li></ul><ul><ul><li>Defined as sustained blood pressure greater than 140/90 mm Hg </li></ul></ul><ul><ul><li>Risk factors include age, diabetes, heredity, high blood lipids (atherosclerosis), obesity, race (African-American), gender (men), smoking </li></ul></ul><ul><ul><li>Treat with lifestyle and diet modifications and medications of other efforts unsuccessful </li></ul></ul><ul><li>Hypotension </li></ul><ul><ul><li>Characterized by fall of 20 mm Hg or more from individual’s normal baseline pressure </li></ul></ul><ul><ul><li>Can be caused by shock, orthostasis (change in body position), overtreatment of hypertension (meds) </li></ul></ul><ul><ul><li>Of no concern in conditioned individual - CV efficiency </li></ul></ul>
  11. 11. Sudden Cardiac Death <ul><li>Hypertrophic cardiomyopathy </li></ul><ul><ul><li>Abnormal thickening of left ventricular wall prior to age 20 </li></ul></ul><ul><ul><li>Leading cause of sudden death in young, active individuals </li></ul></ul><ul><ul><li>Produces impaired ventricular filling, blood flow obstruction and/or arrhythmias </li></ul></ul><ul><li>Mitral valve prolapse </li></ul><ul><ul><li>Regurgitation of blood from left ventricle to left atrium during ventricular contraction </li></ul></ul><ul><ul><li>Results in murmur – often present with chest pain, dyspnea and palpitations during exertion </li></ul></ul><ul><li>Myocarditis </li></ul><ul><ul><li>Infection causing inflammation of muscular walls of heart </li></ul></ul><ul><ul><li>Sudden death occurs when inflammatory changes in heart muscle lead to death of adjacent muscle cells causing life-threatening arrhythmias </li></ul></ul>
  12. 12. Sudden Cardiac Death <ul><li>Acquired valvular heart disease </li></ul><ul><ul><li>Defect/insufficiency in heart valve (stenosis or regurgitation) </li></ul></ul><ul><ul><li>If mild, participation OK – if severe, not recommended </li></ul></ul><ul><li>Coronary artery disease (atherosclerosis) </li></ul><ul><ul><li>Most common cause of sudden death in individuals over 30 </li></ul></ul><ul><ul><li>Impairs blood flow to heart muscle resulting in myocardial infarction (heart attack) </li></ul></ul><ul><li>Marfan’s syndrome </li></ul><ul><ul><li>Genetic condition characterized by arm span exceeding height, hypermobile joints, eye defects and aortic defects </li></ul></ul><ul><ul><li>Sudden death usually from aortic rupture (short life span) </li></ul></ul><ul><li>Arrhythmias </li></ul><ul><ul><li>Several rare conditions resulting in arrhythmias and/or ventricular fibrillation can cause sudden death </li></ul></ul>
  13. 13. Non-Cardiac Causes of Sudden Death <ul><li>Commotio cordis </li></ul><ul><ul><li>Cardiac arrest from low-impact blunt force trauma to the chest in the absence of structural cardiovascular disease </li></ul></ul><ul><li>Substance abuse </li></ul><ul><ul><li>Certain drugs can cause cardiac changes that predispose individual to sudden death (amphetamines, cocaine) </li></ul></ul><ul><ul><li>Erythropoietin is hormone that stimulates red blood cell production – ergogenic aid used to aid performance for endurance athletes – causes increased blood volume/viscosity causing decreased circulation and MI </li></ul></ul>
  14. 14. Non-Cardiac Causes of Sudden Death <ul><li>Head injuries </li></ul><ul><ul><li>Sudden death from catastrophic brain injuries (epidural/subdural hematoma, second-impact syndrome) </li></ul></ul><ul><ul><li>Present with altered vitals, dilated pupil, posturing </li></ul></ul><ul><li>Heat illness </li></ul><ul><ul><li>Secondary to heat stroke, especially if not recognized and treated quickly </li></ul></ul><ul><li>Sickle cell trait </li></ul><ul><ul><li>Secondary to clumping of sickle cells </li></ul></ul><ul><ul><li>Increased risk during exertion in hot/humid environments and at increased altitudes </li></ul></ul>
  15. 15. Neurological Conditions <ul><li>Headaches </li></ul><ul><ul><li>Migraine headaches </li></ul></ul><ul><ul><li>Post-traumatic headaches </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><li>Seizure disorders/epilepsy </li></ul><ul><ul><li>Types of seizures </li></ul></ul><ul><ul><li>Management </li></ul></ul><ul><li>Meningitis </li></ul><ul><li>Encephalitis </li></ul>
  16. 16. Headaches <ul><li>Migraine headaches </li></ul><ul><ul><li>Defined as idiopathic, episodic HA disorder with attacks lasting 4-72 hours </li></ul></ul><ul><ul><ul><li>Recurrent, moderate to severe, acute onset </li></ul></ul></ul><ul><ul><li>Thought to be associated with vascular responses </li></ul></ul><ul><ul><li>Often preceded by aura (flash of light, odor, taste, feeling dizzy, etc.) </li></ul></ul><ul><ul><li>Usually unilateral, nausea/vomiting, photophobia, phonophobia, desire to lay in dark/quiet area </li></ul></ul>
  17. 17. Headaches <ul><li>Post-traumatic headaches </li></ul><ul><ul><li>Most common neurological symptom following head trauma </li></ul></ul><ul><ul><li>Occurs within 2 weeks of trauma and can last up to 8 weeks </li></ul></ul><ul><ul><li>Greater risk if Loss of consciousness and/or amnesia present with head trauma </li></ul></ul><ul><ul><li>Return to play considerations (second impact syndrome, tumors) </li></ul></ul><ul><li>Headache management </li></ul><ul><ul><li>Most treated with medications (OTC vs. Rx) </li></ul></ul>
  18. 18. Seizure Disorders <ul><li>Definitions </li></ul><ul><ul><li>Seizure </li></ul></ul><ul><ul><ul><li>Abnormal discharge of electrical activity from the brain </li></ul></ul></ul><ul><ul><li>Seizure disorder </li></ul></ul><ul><ul><ul><li>Recurrent episodes of sudden, excessive discharges of electrical activity in the brain whether from known or unknown causes </li></ul></ul></ul><ul><ul><li>Epilepsy </li></ul></ul><ul><ul><ul><li>Describes recurrent, idiopathic episodes of sudden, excessive discharges of electrical activity in the brain </li></ul></ul></ul>
  19. 19. Types of Seizures <ul><li>Partial </li></ul><ul><ul><li>Localized onset and presentation, no loss of consciousness </li></ul></ul><ul><ul><li>Sensory/motor deficits, emotional experiences, visual/olfactory/auditory hallucinations, deja vu </li></ul></ul><ul><li>Complex partial </li></ul><ul><ul><li>Large area affected, consciousness impaired </li></ul></ul><ul><ul><li>Purposeful actions in “trance-like” state, no memory </li></ul></ul><ul><li>Generalized </li></ul><ul><ul><li>Grand mal (convulsive) – tonic/clonic, often have aura, may lose bodily function (50-90 seconds, up to 5 minutes) </li></ul></ul><ul><ul><li>Petit mal (non-convulsive) – blank stare (3-15 seconds) </li></ul></ul><ul><li>Special epileptic syndromes </li></ul><ul><ul><li>Febrile seizures in infants/children (102˚F) </li></ul></ul><ul><ul><li>Reflex epilepsy (flickering lights, specific sounds, etc.) </li></ul></ul>
  20. 20. Seizure Management <ul><li>Note time of onset and resolution </li></ul><ul><li>Protect individual from injury </li></ul><ul><ul><li>Remove eyeglasses, nearby objects, etc. and protect head </li></ul></ul><ul><ul><li>Do not restrain person or stop seizure </li></ul></ul><ul><ul><li>Do not place anything in mouth </li></ul></ul><ul><li>Loss of control of bodily function may occur – spectators/observers </li></ul><ul><li>Ensure adequate airway and wait until individual fully awakens – activate EMS if seizure is continuous or if another occurs in rapid succession </li></ul>
  21. 21. Respiratory Tract Conditions <ul><li>Upper respiratory tract infections </li></ul><ul><ul><li>Common cold </li></ul></ul><ul><ul><li>Sinusitis </li></ul></ul><ul><ul><li>Pharyngitis </li></ul></ul><ul><ul><li>Laryngitis </li></ul></ul><ul><ul><li>Tonsillitis </li></ul></ul><ul><ul><li>Allergic rhinitis </li></ul></ul><ul><li>General respiratory conditions </li></ul><ul><ul><li>Bronchitis </li></ul></ul><ul><ul><li>Asthma </li></ul></ul><ul><ul><li>Exercise-induced bronchospasm </li></ul></ul><ul><ul><li>Influenza </li></ul></ul><ul><ul><li>Pneumonia </li></ul></ul>
  22. 22. Upper Respiratory Tract Conditions <ul><li>Common cold </li></ul><ul><ul><li>Primarily accounted for by rhinoviruses, usually 1-6/year </li></ul></ul><ul><ul><li>Sx vary dramatically, treat symptoms with OTC </li></ul></ul><ul><li>Sinusitis </li></ul><ul><ul><li>Inflammation of perinasal sinuses from infection, allergens or environment </li></ul></ul><ul><ul><li>Most common sx are sinus pain and pressure, nasal discharge (often colored if bacterial origin) </li></ul></ul><ul><ul><li>Treat per onset, nasal sprays use OK if limited </li></ul></ul><ul><li>Pharyngitis (sore throat) </li></ul><ul><ul><li>Often associated with other infections </li></ul></ul><ul><ul><li>Treat per onset, gargles, lozenges/sprays </li></ul></ul>
  23. 23. Upper Respiratory Tract Conditions <ul><li>Laryngitis </li></ul><ul><ul><li>Inflammation of vocal chords from infection, environmental exposure and/or vocal overuse </li></ul></ul><ul><ul><li>Hoarse voice or loss of voice </li></ul></ul><ul><ul><li>Treatment per onset but involves vocal rest to avoid irritation </li></ul></ul><ul><li>Tonsillitis </li></ul><ul><ul><li>Infection of tonsils (lymph nodes) at back of throat, often can see pus and/or redness over tonsils </li></ul></ul><ul><ul><li>Treat with antibiotics if bacterial, treat symptoms if viral, tonsillectomy considered if chronic </li></ul></ul><ul><li>Allergic rhinitis (hay fever) </li></ul><ul><ul><li>Inflammation of nasal mucosa from exposure to allergens (pollen, mold, dust, pets, etc.) </li></ul></ul><ul><ul><li>Managed with limited exposure to allergen and antihistamine medications </li></ul></ul>
  24. 24. General Respiratory Conditions <ul><li>Bronchitis </li></ul><ul><ul><li>Inflammation of mucosal lining of bronchii </li></ul></ul><ul><ul><li>May be viral or bacterial, typically have coughing, wheezing and/or large amount of purulent mucous, treat per onset </li></ul></ul><ul><li>Asthma </li></ul><ul><ul><li>Bronchospasm leading to inadequate airflow during respiration (esp. expiration) </li></ul></ul><ul><ul><li>Most common symptom is dyspnea (difficulty breathing), wheezing and anxiety often occur </li></ul></ul><ul><ul><li>Typically treat with bronchodilator inhalers </li></ul></ul>
  25. 25. General Respiratory Conditions <ul><li>Exercise-induced bronchospasm (asthma) </li></ul><ul><ul><li>Diagnosis via forced expiratory volume measure with peak flow meter (10% decrease post-exercise normal, >10% identified as EIB) </li></ul></ul><ul><ul><li>Symptoms are tightness in chest, dyspnea, burning sensation with breathing, cough within 8-10 minutes of exercise, treat per asthma </li></ul></ul><ul><li>Influenza </li></ul><ul><ul><li>Specific viral bronchitis typically occurring in epidemics, immunizations available </li></ul></ul><ul><ul><li>“ Flu-like” symptoms typically start after 1-2 days and last up to 5 days </li></ul></ul><ul><li>Pneumonia </li></ul><ul><ul><li>Infection of lungs, treated per onset (viral vs. bacterial) </li></ul></ul><ul><ul><li>Symptoms vary per onset, but typically include high fever, pleurisy (chest pain), phlegm producing cough </li></ul></ul>
  26. 26. Gastrointestinal Conditions <ul><li>Upper GI disorders </li></ul><ul><ul><li>Gastroesophageal reflux </li></ul></ul><ul><ul><li>Dyspepsia </li></ul></ul><ul><ul><li>Gastric ulcer </li></ul></ul><ul><ul><li>Gastritis </li></ul></ul><ul><ul><li>Gastroenteritis </li></ul></ul><ul><li>Lower GI disorders </li></ul><ul><ul><li>Irritable bowel syndrome </li></ul></ul><ul><ul><li>Crohn’s disease </li></ul></ul><ul><ul><li>Ulcerative colitis </li></ul></ul><ul><ul><li>Constipation </li></ul></ul><ul><ul><li>Diarrhea </li></ul></ul><ul><ul><li>Hemorrhoids </li></ul></ul>
  27. 27. Upper GI Conditions <ul><li>Upper GI conditions at level of stomach or above </li></ul><ul><li>Gastroesophageal reflux </li></ul><ul><ul><li>Regurgitation of gastric juices (acids) into esophagus (“heartburn”) </li></ul></ul><ul><ul><li>Treat with antacids and diet modification </li></ul></ul><ul><li>Dyspepsia (indigestion) </li></ul><ul><ul><li>Upper GI pain without known cause </li></ul></ul><ul><ul><li>Often feels overfull after eating, may have nausea and vomiting, can mimic heartburn </li></ul></ul><ul><ul><li>Treat with antacids and diet/activity modification </li></ul></ul>
  28. 28. Upper GI Conditions <ul><li>Gastric (peptic) ulcer </li></ul><ul><ul><li>Caused by excessive gastric juice production, consumption of excessive alcohol/spicy foods/orange juice/coffee, use of tobacco products </li></ul></ul><ul><ul><li>Common symptom is pain in stomach region within 1-3 hours of irritation </li></ul></ul><ul><li>Gastritis </li></ul><ul><ul><li>Inflammation of stomach lining and erosion of gastric mucosa from anxiety, NSAID overuse, excessive caffeine/alcohol </li></ul></ul><ul><ul><li>May present with GI bleeding, vomiting (hematemesis) </li></ul></ul><ul><li>Gastroenteritis </li></ul><ul><ul><li>Acute inflammation of mucosal membrane of stomach or small intestine from viral/bacterial infection, food poisoning, anxiety, etc. </li></ul></ul><ul><ul><li>Presents with indigestion, nausea/vomiting, gas, diarrhea </li></ul></ul><ul><ul><li>Usually self-limiting in 2-3 days, anti-motility meds, hydration issue </li></ul></ul>
  29. 29. Lower GI Conditions <ul><li>Irritable bowel syndrome </li></ul><ul><ul><li>Altered bowel functions (constipation, diarrhea or alternations of each) combined with abdominal pain with no known cause </li></ul></ul><ul><ul><li>Most common treatment is diet modification </li></ul></ul><ul><li>Crohn’s disease (regional enteritis) </li></ul><ul><ul><li>Chronic, patchy and segmented inflammation of intestine through all layers of intestinal wall resulting in thickening/toughening of wall and narrowing of intestinal pathway </li></ul></ul><ul><li>Ulcerative colitis </li></ul><ul><ul><li>Chronic inflammation of only mucosal lining of large intestine </li></ul></ul><ul><ul><li>Often presents with bloody stools/diarrhea </li></ul></ul>
  30. 30. Lower GI Conditions <ul><li>Constipation </li></ul><ul><ul><li>Infrequent or incomplete bowel movements </li></ul></ul><ul><ul><li>Can occur with insufficient dietary fiber, improper bowel habits, medication side effects </li></ul></ul><ul><li>Diarrhea </li></ul><ul><ul><li>Abnormally loose, watery stools – multiple possible origins </li></ul></ul><ul><ul><li>Treat with anti-diarrhea meds (limited use), hydration concerns </li></ul></ul><ul><li>Hemorrhoids (piles) </li></ul><ul><ul><li>Dilations of veins around rectum/anus </li></ul></ul><ul><ul><li>Present with pain, itching and small amounts of rectal bleeding </li></ul></ul><ul><ul><li>Treat symptoms, typically resolve in 2-3 weeks </li></ul></ul>
  31. 31. Endocrine Conditions <ul><li>Thyroid disorders </li></ul><ul><ul><li>Hyperthyroidism </li></ul></ul><ul><ul><li>Hypothyroidism </li></ul></ul><ul><li>Pancreatitis </li></ul><ul><ul><li>Acute vs. chronic </li></ul></ul><ul><li>Diabetes mellitus </li></ul><ul><ul><li>Types of diabetes </li></ul></ul><ul><ul><li>Complications of diabetes </li></ul></ul><ul><ul><li>Nutrition and exercise recommendations </li></ul></ul>
  32. 32. Thyroid Disorders <ul><li>Thyroid gland produces hormones that regulate rate of body’s use of fats and carbs, regulate body temperature, influence heart rate, regulate production of protein and regulate amount of calcium in blood </li></ul><ul><li>Rate of hormone release from thyroid gland controlled by pituitary gland and hypothalamus </li></ul>
  33. 33. Hyperthyroidism <ul><li>Caused by overproduction of thyroxine hormone – accelerated metabolism </li></ul><ul><li>More common in women ages 30-50 </li></ul><ul><li>Symptoms include goiter (enlarged thyroid), tachycardia, loss of sleep, heat intolerance, ophthalmopathy (bulging eyes) </li></ul><ul><li>Treated with meds that affect thyroid function, partial removal of thyroid or use of radioactive iodine which shrinks the thyroid </li></ul>
  34. 34. Hypothyroidism <ul><li>Caused by insufficient or loss of function of thyroid – lower metabolism </li></ul><ul><li>Most common in women over 40 </li></ul><ul><li>Symptoms include unexplained weight gain, hypertension, goiter, heavier than normal menses, increased sensitivity to cold </li></ul><ul><li>Treat with hormone replacement therapy to normalize levels of hormones </li></ul>
  35. 35. Pancreatitis <ul><li>Pancreas produces digestive juices and enzymes as well as insulin and glucagon for regulation of blood sugar </li></ul><ul><li>Acute pancreatitis </li></ul><ul><ul><li>Primarily caused (90%) by gall stones which blocks ducts and also by alcohol abuse </li></ul></ul><ul><ul><li>Typically self-limiting and treated symptomatically </li></ul></ul><ul><li>Chronic pancreatitis </li></ul><ul><ul><li>Permanent damage (slow, progressive limiting) to pancreatic function primarily from alcohol abuse (high mortality rate) </li></ul></ul><ul><ul><li>Ultimately ceases insulin production causing diabetes </li></ul></ul><ul><ul><li>Treated with pain management, diet modification or surgery </li></ul></ul>
  36. 36. Diabetes Mellitus <ul><li>Types of diabetes </li></ul><ul><ul><li>Type I </li></ul></ul><ul><ul><ul><li>Juvenile onset/insulin dependent, onset before age 30, lean body type, insulin injections required to control blood glucose, common in Whites, minor family history link </li></ul></ul></ul><ul><ul><li>Type II (most common </li></ul></ul><ul><ul><ul><li>Adult onset/non-insulin dependent, onset after age 30, obese body type, insulin injections needed in 20-30% of patients, diet alone often able to control blood glucose, common in Blacks, Native Americans and Hispanics, typically have family history </li></ul></ul></ul><ul><ul><li>Gestational diabetes </li></ul></ul><ul><ul><ul><li>Development of type I diabetes usually during later half of pregnancy </li></ul></ul></ul><ul><ul><ul><li>Typically resolves once baby is delivered </li></ul></ul></ul>
  37. 37. Diabetes Mellitus <ul><li>Complications of diabetes </li></ul><ul><ul><li>Circulatory complications </li></ul></ul><ul><ul><ul><li>Associated with early development and rapid progression of atherosclerosis </li></ul></ul></ul><ul><ul><ul><li>>80% of diabetics die from CV disease (heart attacks) </li></ul></ul></ul><ul><ul><ul><li>Also associated with impaired kidney function and retinal degeneration (loss of vision) </li></ul></ul></ul><ul><ul><li>Nerve complications </li></ul></ul><ul><ul><ul><li>Nerve deterioration results in loss of sensation </li></ul></ul></ul><ul><ul><ul><li>Most prominent in hands/feet </li></ul></ul></ul><ul><ul><ul><li>Unable to feel injuries – may lead to amputation </li></ul></ul></ul>
  38. 38. Diabetes Mellitus <ul><li>Complications of diabetes </li></ul><ul><ul><li>Insulin shock </li></ul></ul><ul><ul><ul><li>Hypoglycemia results from exercise and unbalanced efforts of diet and insulin </li></ul></ul></ul><ul><ul><ul><li>Aggressive/belligerent behavior, pale/cool/clammy skin, decreased performance, treat with sugar (conscious vs. unconscious considerations) </li></ul></ul></ul><ul><ul><li>Diabetic coma </li></ul></ul><ul><ul><ul><li>In absence of insulin, hyperglycemia develops </li></ul></ul></ul><ul><ul><ul><li>Development of diabetic ketoacidosis from inability to metabolize carbohydrates </li></ul></ul></ul><ul><ul><ul><li>Fruity breath, dry/red/warm skin, confusion progressing to coma, treat with insulin </li></ul></ul></ul>
  39. 39. Diabetes Mellitus <ul><li>Nutritional and exercise recommendations </li></ul><ul><ul><li>Type I diabetes nutrition </li></ul></ul><ul><ul><ul><li>Must correlate insulin injections with meals and consider results of exercise (lower blood sugar) </li></ul></ul></ul><ul><ul><ul><li>Ingestion of high carbohydrate foods for pre-activity meals, snacks during activity and after activity meals </li></ul></ul></ul><ul><ul><li>Type II diabetes nutrition </li></ul></ul><ul><ul><ul><li>Must also be aware of carbohydrate ingestion to balance blood sugar and avoid hyper-/hypoglycemia </li></ul></ul></ul><ul><ul><li>Exercise recommendations </li></ul></ul><ul><ul><ul><li>Exercise essential to managing diabetes and also helps minimize risk of cardiovascular disease and peripheral vascular disease complications </li></ul></ul></ul>
  40. 40. Infectious Diseases <ul><li>Common childhood diseases </li></ul><ul><ul><li>Bacterial </li></ul></ul><ul><ul><ul><li>Diptheria, tetanus, whooping cough, Hib </li></ul></ul></ul><ul><ul><li>Viral </li></ul></ul><ul><ul><ul><li>Polio, chicken pox, measles, mumps, German measles </li></ul></ul></ul><ul><ul><li>Atypical presentations due to immunizations </li></ul></ul><ul><li>Infectious mononucleosis </li></ul><ul><li>Viral meningitis </li></ul><ul><li>Sexually transmitted diseases </li></ul>
  41. 41. Bacterial Childhood Diseases <ul><li>Diptheria </li></ul><ul><ul><li>Life-threatening infection of upper respiratory region </li></ul></ul><ul><ul><li>Presents with thick, patchy, gray/blue/white membrane over mucous membranes of throat/palates/nose </li></ul></ul><ul><li>Tetanus (lockjaw) </li></ul><ul><ul><li>Enters through open wounds, puncture most common, often treat with booster shots </li></ul></ul><ul><ul><li>Presents with involuntary muscle spasms, first in jaw/neck </li></ul></ul><ul><li>Whooping cough (pertussis) </li></ul><ul><ul><li>Extremely contagious respiratory infection – must recognize and treat early with antibiotics for effective treatment </li></ul></ul><ul><ul><li>If allowed to progress, presents with violent coughing episodes followed by exhalations with high pitched whoop </li></ul></ul><ul><li>Hib (haemophilus influenzae type b) </li></ul><ul><ul><li>One of leading causes of bacterial disease in kids <5 and also leading cause of meningitis in that group </li></ul></ul><ul><ul><li>Treat aggressively with antibiotics x 2+ weeks </li></ul></ul>
  42. 42. Viral Childhood Diseases <ul><li>Polio (poliomyelitis) </li></ul><ul><ul><li>Inflammation of gray matter of spinal cord </li></ul></ul><ul><ul><li>Results in spinal and muscle paralysis </li></ul></ul><ul><li>Chicken pox (varicella) </li></ul><ul><ul><li>Very contagious but mild disease in children, can be severe in adults </li></ul></ul><ul><ul><li>Characteristic rash starts on trunk/scalp and progresses to extremities </li></ul></ul><ul><li>Mumps (parotitis) </li></ul><ul><ul><li>Most common in children 5-9 years old </li></ul></ul><ul><ul><li>Most common symptom is swollen salivary (parotid) glands with associated lack of desire to swallow (eat/drink) </li></ul></ul>
  43. 43. Viral Childhood Diseases <ul><li>Measles (rubeola) </li></ul><ul><ul><li>Short incubation period (7-18 days), high fever (103-105˚F), Koplik’s spots in mouth (blue/gray specks with red halo), rash starts on head/neck and progresses to body, longer resolution (3-5 days) </li></ul></ul><ul><li>German measles (rubella) </li></ul><ul><ul><li>Mild disease in children and adults, severe risk if to unborn child during pregnancy </li></ul></ul><ul><ul><li>Long incubation period (14-23 days, low-grade fever, rash starting on face and spreads to body, quick resolution (2-3 days) </li></ul></ul>
  44. 44. Infectious Mononucleosis <ul><li>Caused by Epstein-Barr virus </li></ul><ul><li>Commonly called “kissing disease” due to transmission through saliva </li></ul><ul><li>Symptoms include headache, malaise, fatigue, severe sort throat </li></ul><ul><li>Splenic enlargement occurs to fight virus – risk of rupture (especially in contact sports) – usually screen with ultrasound before clearing for return to play </li></ul>
  45. 45. Viral Meningitis <ul><li>Inflammation of lining of central nervous system – rare, but severe disease </li></ul><ul><li>Can be exposed from water bottles, water coolers, drink dispensing machines that aren’t kept clean </li></ul><ul><li>Severe symptoms and can be fatal </li></ul>
  46. 46. Sexually Transmitted Diseases <ul><li>Affect >12 million Americans annually </li></ul><ul><ul><li>Greatest risk in 15-19 year olds </li></ul></ul><ul><li>Chlamydia is most common bacterial STD in US, preventable with safe sex practices, treated with antibiotics </li></ul><ul><li>Gonorrhea is second most common STD </li></ul><ul><ul><li>In men, have yellow/green discharge and pain with urination – in women, often no symptoms until progresses to PID </li></ul></ul><ul><li>Herpes simplex II typically results in genital ulcers, once exposed = always present but usually dormant </li></ul><ul><li>Genital warts from human papilloma virus present with cauliflower like appearance on genetalia </li></ul>
  47. 47. Dermatological Conditions <ul><li>Bacterial conditions </li></ul><ul><ul><li>Abcess, acne, paronychia, folliculitis, furuncles/carbuncles, cellulitis, impetigo </li></ul></ul><ul><li>Fungal conditions (tinea) </li></ul><ul><ul><li>Pedis, cruris, corporis, capitis, versicolor, candidiasis </li></ul></ul><ul><li>Viral conditions </li></ul><ul><ul><li>Herpes, warts </li></ul></ul><ul><li>Other conditions </li></ul><ul><ul><li>Eczema, psoriasis, hyperhidrosis, contact dermatitis, urticaria, bites and stings </li></ul></ul>
  48. 48. Bacterial Dermatological Conditions <ul><li>Abcess </li></ul><ul><ul><li>Circumscribed collection of pus in a localized infection, may be a cavity formed by liquefaction necrosis of solid tissue </li></ul></ul><ul><li>Acne </li></ul><ul><ul><li>Blockage of sebaceous glands resulting in bacterial infection </li></ul></ul><ul><ul><li>Presents as blackheads or whiteheads, most common to face/neck/back regions </li></ul></ul><ul><li>Paronychia </li></ul><ul><ul><li>Occurs at lateral borders of nails (“ingrown nails”) usually secondary to hangnail or trimming too close </li></ul></ul><ul><ul><li>Area becomes red/swollen/painful, typically treated with soaks and occasionally surgically removed </li></ul></ul><ul><li>Folliculitis </li></ul><ul><ul><li>Inflammation of a hair follicle (“ingrown hair”) usually presenting with pustule at site </li></ul></ul><ul><ul><li>More common with short/coarse hair and subsequent to friction from clothing, equipment and/or shaving </li></ul></ul>
  49. 49. Bacterial Dermatological Conditions <ul><li>Furuncles (boil)/carbuncles </li></ul><ul><ul><li>Furuncles is singular and carbuncles is cluster of furuncles </li></ul></ul><ul><ul><li>Complication of folliculitis that goes deeper than follicle and develops into pustule of walled-off purlument material </li></ul></ul><ul><li>Cellulitits </li></ul><ul><ul><li>Painful infection of dermis and subcutaneous tissues </li></ul></ul><ul><ul><li>Often appears as tender, reddened and “tight” area of skin over infected region </li></ul></ul><ul><li>Impetigo </li></ul><ul><ul><li>Highly contagious via direct contact </li></ul></ul><ul><ul><li>Presents with sores that rupture and form honey-colored crust that then turns red </li></ul></ul><ul><ul><li>Most common to face/neck region </li></ul></ul>
  50. 50. Fungal Dermatological Conditions <ul><li>All tinea infections are “ringworm” </li></ul><ul><ul><li>Preventable with personal hygiene and facility cleansing considerations </li></ul></ul><ul><li>Tinea pedis (“athlete’s foot”) </li></ul><ul><ul><li>Most common, typically transferred in locker rooms/showers, very itchy </li></ul></ul><ul><li>Tinea cruris (“jock itch”) </li></ul><ul><ul><li>More common in men than women </li></ul></ul><ul><li>Tinea capitis </li></ul><ul><ul><li>On scalp – starts small and enlarges – may see bald spots in areas of infection </li></ul></ul>
  51. 51. Fungal Dermatological Conditions <ul><li>Tinea corporis </li></ul><ul><ul><li>On body – presents with circular patches of scaly skin with raised borders – common on trunk and axillas in wrestlers </li></ul></ul><ul><li>Tinea versicolor </li></ul><ul><ul><li>Most commonly identified after sun exposure – infected area lighter in color </li></ul></ul><ul><ul><li>Not contagious </li></ul></ul><ul><li>Candidiasis </li></ul><ul><ul><li>Yeast fungal infection of skin or vagina from friction in hot/moist/humid area </li></ul></ul><ul><li>All fungal infections treated with antifungal medications and changing/avoidance of warm, most environments </li></ul>
  52. 52. Viral Dermatological Conditions <ul><li>Herpes </li></ul><ul><ul><li>Gladiatorum </li></ul></ul><ul><ul><ul><li>Caused by herpes type I virus </li></ul></ul></ul><ul><ul><ul><li>Presents with clusters of vesicles, itchy – treat outbreaks with antiviral meds, limit participation when infection is active </li></ul></ul></ul><ul><ul><li>Zoster (shingles) </li></ul></ul><ul><ul><ul><li>Presents as red rash with blisters, most common on torso </li></ul></ul></ul><ul><ul><ul><li>Can treat successfully with antivirals early </li></ul></ul></ul><ul><li>Warts (verrucae) </li></ul><ul><ul><li>Caused by human papilloma virus (HPV) </li></ul></ul><ul><ul><li>Most common on hands (small, round, elevated) and feet (plantar warts – dark dots) </li></ul></ul><ul><ul><li>Burn, freeze or remove with scalpel </li></ul></ul>
  53. 53. Other Dermatological Conditions <ul><li>Eczema </li></ul><ul><ul><li>Inflammation of the skin characterized by redness, scaling and exudate, typically itches increasing risk of other infections </li></ul></ul><ul><li>Psoriasis </li></ul><ul><ul><li>Characterized by rapid buildup of rough, dry, dead skin cells forming thick scales </li></ul></ul><ul><ul><li>Most common on elbows, knees, scalp and gluteal cleft </li></ul></ul><ul><li>Hyperhidrosis </li></ul><ul><ul><li>Excessive perspiration especially to palms and axillary regions </li></ul></ul><ul><ul><li>Can be especially problematic in activities that require holding objects (balls, racquets, oars, etc.) </li></ul></ul>
  54. 54. Other Dermatological Conditions <ul><li>Contact dermatitis </li></ul><ul><ul><li>Allergic – direct contact with substance (tape, soaps, etc.) causing local inflammatory reaction </li></ul></ul><ul><ul><li>Irritant – results when skin is damaged or ulcerated (friction burns from turf or equipment) </li></ul></ul><ul><li>Urticaria (hives) </li></ul><ul><ul><li>Elevated, red, itchy wheal secondary to hypersensitivity to foods, drugs, infections, heat, cold, chemicals </li></ul></ul><ul><li>Bites and stings </li></ul><ul><ul><li>Typically relatively benign unless anaphylaxis occurs </li></ul></ul><ul><ul><li>Symptoms include respiratory distress, rapid/weak pulse, hypotension, numbness, seizures, unconsciousness, etc. – can be life-threatening </li></ul></ul><ul><ul><li>Treat with administration of epinephrine via Epi-Pen device which typically isn’t definitive care, but buys time for that to occur </li></ul></ul>
  55. 55. Special Population Conditions <ul><li>Female athletes </li></ul><ul><ul><li>Menstrual disorders </li></ul></ul><ul><ul><li>Eating disorders </li></ul></ul><ul><ul><li>Osteoporosis </li></ul></ul><ul><li>Athletes with disabilities </li></ul><ul><ul><li>Wheelchair athletes </li></ul></ul><ul><ul><li>Amputees </li></ul></ul><ul><ul><li>Cerebral palsy </li></ul></ul><ul><ul><li>Visual impairment </li></ul></ul><ul><li>Senior athlete considerations </li></ul>
  56. 56. Female Athlete Conditions <ul><li>Menstrual disorders </li></ul><ul><ul><li>Dysmenorrhea </li></ul></ul><ul><ul><ul><li>Menstrual cramps from overproduction of prostaglandins that cause uterine muscle to contract, most problematic during first few days of menstrual cycle </li></ul></ul></ul><ul><ul><ul><li>Often treated with OTC meds to relieve pain and cramping </li></ul></ul></ul><ul><ul><li>Exercise-induced amenorrhea </li></ul></ul><ul><ul><ul><li>Primary amenorrhea is absence of menstruation by age 16 </li></ul></ul></ul><ul><ul><ul><li>Secondary amenorrhea is absence of menstruation for 3+ cycles after menarche </li></ul></ul></ul><ul><ul><ul><li>Often associated with weight loss, low body fat and excessive exercise, especially in women endurance athletes </li></ul></ul></ul><ul><ul><ul><li>Reduced bone density and increased risk of stress fracture </li></ul></ul></ul>
  57. 57. Female Athlete Conditions <ul><li>Eating disorders </li></ul><ul><ul><li>Bulemia nervosa </li></ul></ul><ul><ul><ul><li>Characterized by binge/purge behavior, typically have normal body weight for age/height </li></ul></ul></ul><ul><ul><ul><li>Use vomiting, laxatives, diuretics to purge </li></ul></ul></ul><ul><ul><li>Anorexia nervosa </li></ul></ul><ul><ul><ul><li>Characterized by distorted body image, excessive exercise, controlled eating habits and body weight 15% below normal for age/height </li></ul></ul></ul><ul><li>Osteoporosis </li></ul><ul><ul><li>Decreased bone mass/strength and associated increased risk of bony injury </li></ul></ul><ul><ul><li>Component of “Female Triad” with amenorrhea (inadequate estrogen for bone health) and disordered eating habits (improper nutrition and mineral levels </li></ul></ul><ul><ul><ul><li>Most common in activities with “appearance” characteristics associated with achievement (gymnastics, swimming/diving, figure skating, etc.) </li></ul></ul></ul>
  58. 58. Athletes With Disabilities <ul><li>Wheelchair athletes </li></ul><ul><ul><li>Upper extremity strains/sprains, blisters and neurological injuries common due to propulsion efforts </li></ul></ul><ul><ul><li>Higher risk of heat illness due to decreased ability to sweat and regulate body temperature </li></ul></ul><ul><li>Amputees </li></ul><ul><ul><li>Most common problem is irritation at junction of limb and prosthetic device, especially in LE due to weight-bearing </li></ul></ul><ul><li>Cerebral palsy </li></ul><ul><ul><li>Muscle strains are common due to increased load on muscle/tendon units due to constant spasticity and decreased joint range of motion </li></ul></ul><ul><li>Visual impairment </li></ul><ul><ul><li>Increased risk from collision with obstacles and decreased ability to respond to surface changes </li></ul></ul>
  59. 59. Senior Athlete Considerations <ul><li>Growing concern with aging and more active population </li></ul><ul><li>Decreased bone mass, decreased tissue elasticity, muscle fiber atrophy, cartilage degeneration all associated with aging </li></ul><ul><ul><li>Adhesive capsulitis in shoulder, Achilles tendon rupture, plantar fascia tears, etc. are common </li></ul></ul><ul><li>Physical activity generally delays onset of these changes </li></ul>